Golf injuries - common and potentially avoidable

Epidemiology of Musculoskeletal Injuries in Golf Athletes: A Championship in Portugal

Although golf is a low-impact sport without physical contact, its movements are carried out over a large range of motion, and their repetition can predispose athletes to the development of injuries. This study aimed to investigate the epidemiology of musculoskeletal injuries in golf athletes who participated in championships in southern Portugal, determining the types, locations and mechanisms of injury and their associated risk factors. The sample consisted of 140 athletes aged between 18 and 72 years, 133 (95%) being male. The measuring instrument was a questionnaire about sociodemographics, modality and injuries' characteristics. Throughout golf practice, 70 (50%) athletes reported injuries, totaling 133 injuries. In the 12-month period, 43 (30.7%) athletes suffered injuries, totaling 65 injuries. The injury proportion was of 0.31, and the injury rate was of 0.33 injuries per 1000 h of golf training. The most common injury type was muscle sprain or rupture (19; 30.9%), located in the lumbar spine (17; 27%), in which the repetitive movements were the main injury mechanism (42; 66.7%). The athletes who trained 4 times or more per week were 3.5 more likely (CI: 0.97-12.36; p = 0.056) to develop an injury while playing golf. Moderate injury presence was observed, with the high training frequency being an associated risk factor.

Epidemiology of musculoskeletal injury in professional and amateur golfers: a systematic review and meta-analysis

OBJECTIVE

To determine the prevalence and incidence of musculoskeletal injury in amateur and professional golfers, and to identify common injury sites and factors associated with increased injury frequency.

DESIGN

Systematic epidemiological review and meta-analysis.

DATA SOURCES

PubMed (Medline), Embase, the Cochrane Library and SPORTDiscus were searched in September 2023.

ELIGIBILITY CRITERIA

Studies published in the English language reporting the incidence or prevalence of musculoskeletal injuries in golfers at all anatomical sites.

RESULTS

20 studies (9221 golfers, 71.9% male, 28.1% female) were included, with mean age 46.8 years. Lifetime injury prevalence was significantly greater in professional golfers (73.5% (95% CI: 47.3% to 93.0%)) than amateur golfers (56.6% (95% CI: 47.4% to 65.5%); relative risk (RR)=1.50, p<0.001). Professional golfers had a significantly greater lifetime prevalence of hand and wrist (RR=3.33, p<0.001) and lower back injury (RR=3.05, p<0.001). Soft tissue injuries were most common, and diagnoses were typically non-specific. Injury frequency was not associated with age or sex. Two studies reported a greater injury risk in amateur golfers playing more than three and four rounds per week.

CONCLUSION

Over half of golfers are at risk of sustaining a musculoskeletal injury during their lifetime. Risks and patterns of injury differ between professional and amateur golfers, with professionals significantly more likely to develop lower back, and hand and wrist injuries. A recent international consensus statement on the reporting of injury and illness in golf should aid consistency in future research assessing the epidemiology of specific diagnoses, informing golf injury prevention and management strategies.

PROSPERO REGISTRATION NUMBER

CRD42023408738.

The effectiveness of a golf injury prevention program (GRIPP intervention) compared to the usual warm-up in Dutch golfers: protocol design of a randomized controlled trial

Background

Sixty million golfers around the world play golf. Golf injuries are most frequently located in the spine, elbow, wrist, hand and shoulder. Those injuries are often seen in golfers with more playing hours and suboptimal swing biomechanics, resulting in overuse injuries. Golfers who do not perform a warm-up or do not warm-up appropriately are more likely to report an injury than those who do. There are several ways to warm-up. It is unclear, which warm-up is most useful for a golfer to perform. Moreover, there is currently no evidence for the effectiveness of a warm-up program for golf injury prevention. We previously have developed the Golf Related Injury Prevention Program (GRIPP) intervention using the Knowledge Transfer Scheme (KTS). We aim to evaluate the effect of the GRIPP intervention on golf-related injuries. The hypothesis is that the GRIPP intervention program will reduce the number of golf-related injuries.

Methods and design

The GRIPP study is a two-armed randomized controlled trial. Twenty-eight golf clubs with 11 golfers per club will be randomly allocated to the intervention or control group. The intervention group will perform the GRIPP intervention program, and the control group will perform their warm-up as usual. The GRIPP intervention is conducted with the Knowledge Transfer Scheme framework, which is a systematic process to develop an intervention. The intervention consists of 6 exercises with a maximum total of 10 min. The primary outcome is the overall prevalence (%) of golf injuries measured with the Oslo Sports Trauma Research Center (OSTRC-H) questions on health problems every fortnight. The secondary outcome measures will be exposure to golf and compliance to the intervention program.

Discussion

In other sports warm-up prevention programs are effective in reducing the risk of injuries. There are no randomized trials on golf injury prevention. Therefore, an individual unsupervised golf athlete intervention program is conducted which reflects the daily practice of predominantly unsupervised exposure of amateur golfers.

Trial registration

The trial is retrospectively (28 October 2021) registered at the Dutch Trial Register: NL9847 (https://trialsearch.who.int).

Golf and Health, More than 18 Holes—A Bibliometric Analysis

Despite golf’s contribution to health, scientific production related to golf and health has been relatively scarce. This work aims to investigate the state of the art on golf and health and to identify existing gaps and the principal and most notable potential future research trends, contributing to connecting the reality of the facilities dedicated to the practice of this sport and its contribution to raising awareness of the importance of sport in maintaining health. A total of 179 articles were analyzed following the steps for systematic reviews and meta-analysis protocols based on the PRISMA 2020 methodology and QUORUM, and a bibliometric analysis was carried out. Research to date has mainly focused on the benefits of golf in improving health, preventing illness, slowing down aging, or as rehabilitation and on exploring the risks and injuries involved in playing golf. The different ways of promoting participation or changing the image of golf by showing its healthy side are outlined as research trends in the coming years. There is a lack of exploration of the use of technology, the effects of the sport on certain disorders related to psychosocial factors, and further knowledge of the relationships between playing intentions and health. This research provides essential information for researchers who plan to work with golf in the future.

Injuries associated with golf: A qualitative study

Background

Golf is a popular sport played worldwide. The majority of professional golfers work as teaching professionals based at golf clubs. All professional players spend numerous hours on the golf course, placing themselves at increased risk of injury. There have been no recent, large studies investigating injury patterns among male and female professional golfers.

Objective

To investigate the frequency, types and mechanism of injury sustained by male and female professional golfers and to compare injury patterns between touring and teaching professionals.

Methods

Injury data was analyzed from 77 amateur golfers recruited through a questionnaire asking about their different injuries. A web based survey was conducted focusing on injury frequency, location and mechanism and any subsequent time loss. Factors such as side of injury, investigations for the injury were noted.

Results

The study enlisted the participation of 76 patients. One was excluded due to incomplete questionairres Injuries were reported by 34 patients (45%). Eleven patients said they had an elbow injury. The relationship between the number of years the individuals had been playing golf and their history of injury was shown to be significant (p = 0.0257). Warm up and injury have a statistically significant relationship (p = 0.846).

Conclusion

In order to contribute to making golf a safer and hence more enjoyable lifetime activity, a greater knowledge of golf-related injuries is required. This study attempts to do so, and the elbow was discovered to be the most damaged region.

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Golf is a popular and rapidly expanding sports in the world.

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Golf is a safe activity due to its ostensibly innocuous nature, but a growing body of evidence shows that this is not necessarily the case.

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The goal of this research was to look at the injury profile of golfers from a prestigious golf club in Lahore, Pakistan.

Is Golf a Contact Sport? Protection of the Spine and Return to Play After Lumbar Surgery

STUDY DESIGN

Narrative review.

OBJECTIVE

To address the gap in the literature on specific return to play protocols and rehabilitation regimens for golfers undergoing lumbar spine surgery with a high impact swing.

METHODS

This review did not involve patient care or any clinical prospective or retrospective review of patient information and thus did not warrant institutional review board approval. The available literature of PubMed, Medline, and OVID was utilized to review the existing literature.

RESULTS

Studies have shown that the forces through the lumbar spine in the modern-era golf swing are like other contact sports. Methods of protecting the lumbar spine include proper swing mechanics, abdominal and paraspinal musculature strengthening and flexibility as well as physical fitness. There are a variety of treatment options available to treat lumbar spine pathology each with a different return to play recommendations from doctors in the field.

CONCLUSIONS

With the introduction of a high impact, modern-era swing to the game of golf, the pathology is seen in the lumbar spine of both young, old, professional, and amateur golfers with low back pain are similar to other athletes in contact sports. Surgery is effective in returning athletes to a similar level of play even though no protocols exist for an effective and safe return. There have been many studies conducted to determine appropriate treatment and return to play for these injuries, but there is a gap in the literature on specific return to play protocols and rehabilitation regimens for golfers undergoing lumbar spine surgery with a high impact swing. As return to competitive play is important, especially with professional golfers, studies combining the use of swing mechanics changes, rehabilitation regimens and the type of surgery performed would be able to provide some insight into this topic now that golf may begin to be considered a contact sport.

International consensus statement: methods for recording and reporting of epidemiological data on injuries and illnesses in golf

Epidemiological studies of injury in elite and recreational golfers have lacked consistency in methods and definitions employed and this limits comparison of results across studies. In their sports-generic statement, the Consensus Group recruited by the IOC (2020) called for sport-specific consensus statements. On invitation by International Golf Federation, a group of international experts in sport and exercise medicine, golf research and sports injury/illness epidemiology was selected to prepare a golf-specific consensus statement. Methodological stages included literature review and initial drafting, online feedback from the consensus group, revision and second draft, virtual consensus meetings and completion of final version. This consensus statement provides golf-specific recommendations for data collection and research reporting including: (i) injury and illness definitions, and characteristics with golf-specific examples, (ii) definitions of golf-specific exposure measurements and recommendations for the calculation of prevalence and incidence, (iii) injury, illness and exposure report forms for medical staff and for golfers, and (iv) a baseline questionnaire. Implementation of the consensus methodology will enable comparison among golf studies and with other sports. It facilitates analysis of causative factors for injuries and illness in golf, and can also be used to evaluate the effects of prevention programmes to support the health of golfers.

Prevalence of low back pain among athletes: A systematic review

BACKGROUND

The prevalence of low back pain (LBP) in athletes across a variety of time frames and sports is not known.

OBJECTIVES

To systematically collate and appraise studies on the prevalence of LBP in athletes and stratify by point, one year and life-time prevalence.

METHODS

A comprehensive search was conducted in February 2016. The following sources were individually searched: PubMed (1950 to present), Ovid SP Medline (1950 to present), ISI (1982 to present) and Google Scholar; Surveys were included if they aimed to report the prevalence of LBP amongst the athletes. Two reviewers independently evaluated the methodological quality of the studies.

RESULTS

The literature search generated 4379 records. Title and/or abstracts were reviewed by two investigators and full-texts of 201 relevant articles were selected for further evaluation. Studies were included if they reported the prevalence of LBP in an athletic population (any level of participation in sports and any age range) and were written in English. Furthermore, to adequately assess the prevalence rate, studies had to report the number of athletes with LBP as a percentage of the total number of athletes. Studies that did not contain necessary data to calculate prevalence rate including case reports and non-original studies were excluded and 41 studies entered the bias assessment step. A bias assessment was applied to the methodology of 41 studies, and 36 with low to moderate risk for bias were included in this review. LBP in athletes was shown to have a point prevalence ranging from 10% to 67%, a one-year prevalence ranging from 17% to 94%, and a life-time prevalence ranging from 33% to 84%. The highest prevalence of LBP was found among skiers, floorball players and rowers and the lowest were found in shooters, golfers and triathletes.

CONCLUSION

Like general population, LBP is quite prevalent among athletes. There is a lack of sound data on the prevalence and mechanism of LBP in some popular sports such as volleyball, swimming and track and field. The lack of standardization of research methods and outcome measurement tools are significant problems in literature. Researchers need to use standard and internationally acceptable definitions for LBP and related functional disability. Investigators are encouraged to conduct epidemiologic studies, along with search for possible mechanism of LBP, by recruitment of large sample population of the athletes who are selected through randomization of the national population and adopt recent recommendations for a standard definition of LBP.

Return to Golf After Arthroscopic Management of Femoroacetabular Impingement Syndrome

PURPOSE

To investigate if patients who reported playing golf before arthroscopic hip surgery for femoroacetabular impingement syndrome were able to return to playing golf postoperatively.

METHODS

The study was a retrospective analysis of all consecutive patients undergoing hip arthroscopy for femoroacetabular impingement syndrome between 2012 and 2014. Inclusion criteria required that a patient (1) reported playing golf before the surgery, (2) had a minimum 2-year follow-up, and (3) completed patient-reported outcome measures. An electronic postoperative return to golf questionnaire was completed by patients who reported golf as an activity. To evaluate patients' ability to return to golf after surgery, the following variables were analyzed with paired samples t test and χ-square tests: handedness, holes played, modified-Harris Hip Score, and Hip Outcome Score Activity of Daily Living and Sports-Specific Subscale.

RESULTS

A total of 29 patients (22 men; age, 36.0 ± 11.9 years) with a minimum of 24 months of follow-up who self-reported playing golf preoperatively were included in the analysis. Preoperatively, 23 patients (79%) had discontinued golfing owing to activity-related hip complaints. At the final follow-up, all patients had significant improvements in the Hip Outcome Score Activity of Daily Living (preoperatively, 65.9 ± 19.9; postoperatively, 91.5 ± 12.8; P < .0001), the Hip Outcome Score Sports-Specific Subscale (38.2 ± 23.5, 79.7 ± 28.8; P = .0002), and modified-Harris Hip Score (54.8 ± 15.6; 84.2 ± 15.8; P < .0001). Additionally, there was a decrease in pain from 7.34 ± 1.63 to 1.71 ± 2.3 postoperatively (P < .0001), and 97% of patients returned to golf at an average of 7.2 months postoperatively. Postoperatively, 55% of patients (n = 16) noted improved golfing performance, 41% (n = 11) returned to their preinjury level, 1 patient (3%) returned at a lower level owing to non-hip-related problems, and 1 (3%) did not return to golf owing to fear of reinjury.

CONCLUSIONS

Arthroscopic treatment of femoroacetabular impingement syndrome in patients who reported playing golf before surgery resulted in significant improvements in hip function and predictably high rates of patient satisfaction, with 97% returning to golfing activity and 55% noting improvement from preinjury sporting performance.

LEVEL OF EVIDENCE

Level IV, retrospective case series.

Risk Factors for Knee Injury in Golf: A Systematic Review

Background

Golf is commonly considered a low-impact sport that carries little risk of injury to the knee and is generally allowed following total knee arthroplasty (TKA). Kinematic and kinetic studies of the golf swing have reported results relevant to the knee, but consensus as to the loads experienced during a swing and how the biomechanics of an individual’s technique may expose the knee to risk of injury is lacking.

Objectives

Our objective was to establish (1) the prevalence of knee injury resulting from participation in golf and (2) the risk factors for knee injury from a biomechanical perspective, based on an improved understanding of the internal loading conditions and kinematics that occur in the knee from the time of addressing the ball to the end of the follow-through.

Methods

A systematic literature search was conducted to determine the injury rate, kinematic patterns, loading, and muscle activity of the knee during golf.

Results

A knee injury prevalence of 3–18% was established among both professional and amateur players, with no clear dependence on skill level or sex; however, older players appear at greater risk of injury. Studies reporting kinematics indicate that the lead knee is exposed to a complex series of motions involving rapid extension and large magnitudes of tibial internal rotation, conditions that may pose risks to the structures of a natural knee or TKA. To date, the loads experienced by the lead knee during a golf swing have been reported inconsistently in the literature. Compressive loads ranging from 100 to 440% bodyweight have been calculated and measured using methods including inverse dynamics analysis and instrumented knee implants. Additionally, the magnitude of loading appears to be independent of the club used.

Conclusions

This review is the first to highlight the lack of consensus regarding knee loading during the golf swing and the associated risks of injury. Results from the literature suggest the lead knee is subject to a higher magnitude of stress and more demanding motions than the trail knee. Therefore, recommendations regarding return to golf following knee injury or surgical intervention should carefully consider the laterality of the injury.

Electronic supplementary material

The online version of this article (doi:10.1007/s40279-017-0780-5) contains supplementary material, which is available to authorized users.

Golf Swing Rotational Velocity: The Essential Follow-Through

Objective

To evaluate if shoulder and pelvic angular velocities differ at impact or peak magnitude between professional and amateur golfers. Golf swing rotational biomechanics are a key determinant of power generation, driving distance, and injury prevention. We hypothesize that shoulder and pelvic angular velocities would be highly consistent in professionals.

Methods

Rotational velocities of the upper-torso and pelvis throughout the golf swing and in relation to phases of the golf swing were examined in 11 professionals and compared to 5 amateurs using three-dimensional motion analysis.

Results

Peak rotational velocities of professionals were highly consistent, demonstrating low variability (coefficient of variation [COV]), particularly upper-torso rotational velocity (COV=0.086) and pelvic rotational velocity (COV=0.079) during down swing. Peak upper-torso rotational velocity and peak X-prime, the relative rotational velocity of uppertorso versus pelvis, occurred after impact in follow-through, were reduced in amateurs compared to professionals (p=0.005 and p=0.005, respectively) and differentiated professionals from most (4/5) amateurs. In contrast, peak pelvic rotational velocity occurred in down swing. Pelvic velocity at impact was reduced in amateurs compared to professionals (p=0.019) and differentiated professionals from most (4/5) amateurs.

Conclusion

Golf swing rotational velocity of professionals was consistent in pattern and magnitude, offering benchmarks for amateurs. Understanding golf swing rotational biomechanics can guide swing modifications to help optimize performance and prevent injury.

Guidance for sports injury surveillance: the 20-year influence of the Australian Sports Injury Data Dictionary

Background

Injury prevention requires information about how, why, where and when injuries occur. The Australian Sports Injury Data Dictionary (ASIDD) was developed to guide sports injury data collection and reporting. Sports Medicine Australia (SMA) disseminated associated data collection forms and an online tool to practitioners and the sports community. This paper assesses the long-term value, usefulness and relevance of the ASIDD and SMA tools.

Methods

A systematic search strategy identified both peer-reviewed and grey literature that used the ASIDD and/or the SMA tools, during 1997–2016. A text-based search was conducted within 10 electronic databases, as well as a Google Image search for the SMA tools. Documents were categorised according to ASIDD use as: (1) collected injury data; (2) informed data coding; (3) developed an injury data collection tool and/or (4) reference only.

Results

Of the 36 peer-reviewed articles, 83% directly referred to ASIDD and 17% mentioned SMA tools. ASIDD was mainly used for data coding (42%), reference (36%), data collection (17%) or resource development (14%). In contrast, 86% of 66 grey literature sources referenced, used or modified the SMA data collection forms.

Conclusions

The ASIDD boasts a long history of use and relevance. Its ongoing use by practitioners has been facilitated by the ready availability of specific data collection forms by SMA for them to apply to directly their settings. Injury prevention practitioners can be strongly engaged in injury surveillance activities when formal guidance is supported by user-friendly tools directly relevant to their settings and practice.

Golf-related injuries treated in United States emergency departments

OBJECTIVE

This study investigates unintentional non-fatal golf-related injuries in the US using a nationally representative database.

METHODS

This study analyzed golf-related injuries treated in US hospital emergency departments from 1990 through 2011 using the National Electronic Injury Surveillance System database. Injury rates were calculated using golf participation data.

RESULTS

During 1990 through 2011, an estimated 663,471 (95% CI: 496,370-830,573) individuals ≥7years old were treated in US emergency departments for golf-related injuries, averaging 30,158 annually or 12.3 individuals per 10,000 golf participants. Patients 18-54years old accounted for 42.2% of injuries, but injury rates per 10,000 golf participants were highest among individuals 7-17years old (22.1) and ≥55years old (21.8) compared with 18-54years old (7.6). Patients ≥55years old had a hospital admission rate that was 5.01 (95% CI: 4.12-6.09) times higher than that of younger patients. Injured by a golf club (23.4%) or struck by a golf ball (16.0%) were the most common specified mechanisms of injury. The head/neck was the most frequently injured body region (36.2%), and sprain/strain (30.6%) was the most common type of injury. Most patients were treated and released (93.7%) and 5.9% required hospitalization.

CONCLUSIONS

Although golf is a source of injury among all age groups, the frequency and rate of injury were higher at the two ends of the age spectrum. Given the higher injury and hospital admission rates of patients ≥55years, this age group merits the special attention of additional research and injury prevention efforts.

Comparison of Thoracic and Lumbar Erector Spinae Muscle Activation Before and After a Golf Practice Session

Lower back pain is commonly associated with golfers. The study aimed: to determine whether thoracic- and lumbar-erector-spinae muscle display signs of muscular fatigue after completing a golf practice session, and to examine the effect of the completed practice session on club head speed, ball speed and absolute carry distance performance variables. Fourteen right-handed male golfers participated in the laboratory-based-study. Surface electromyography (EMG) data was collected from the lead and trail sides of the thoracic- and lumbar-erector-spinae muscle. Normalized root mean squared (RMS) EMG activation levels and performance variables for the golf swings were compared before and after the session. Fatigue was assessed using median frequency (MDF) and RMS during the maximum voluntary contraction (MVC) performed before and after the session. No significant differences were observed in RMS thoracic- and lumbar-erector-spinae muscle activation levels during the five phases of the golf swing and performance variables before and after the session (p > .05). Significant changes were displayed in MDF and RMS when comparing the MVC performed before and after the session (p < .05). Fatigue was evident in the trail side of the erector-spinae muscle after the session.

The relationships between golf and health: a scoping review

OBJECTIVE

To assess the relationships between golf and health.

DESIGN

Scoping review.

DATA SOURCES

Published and unpublished reports of any age or language, identified by searching electronic databases, platforms, reference lists, websites and from consulting experts.

REVIEW METHODS

A 3-step search strategy identified relevant published primary and secondary studies as well as grey literature. Identified studies were screened for final inclusion. Data were extracted using a standardised tool, to form (1) a descriptive analysis and (2) a thematic summary.

RESULTS AND DISCUSSION

4944 records were identified with an initial search. 301 studies met criteria for the scoping review. Golf can provide moderate intensity physical activity and is associated with physical health benefits that include improved cardiovascular, respiratory and metabolic profiles, and improved wellness. There is limited evidence related to golf and mental health. The incidence of golfing injury is moderate, with back injuries the most frequent. Accidental head injuries are rare, but can have serious consequences.

CONCLUSIONS

Practitioners and policymakers can be encouraged to support more people to play golf, due to associated improved physical health and mental well-being, and a potential contribution to increased life expectancy. Injuries and illnesses associated with golf have been identified, and risk reduction strategies are warranted. Further research priorities include systematic reviews to further explore the cause and effect nature of the relationships described. Research characterising golf's contribution to muscular strengthening, balance and falls prevention as well as further assessing the associations and effects between golf and mental health are also indicated.

Analysis of ipsilateral and bilateral ratios in male amateur golfers

The number of injuries that force golfers to quit is also increasing. In particular, the upper body injuries are concerns for amateur golfers. This study was conducted not only to investigate muscular balance, such as ipsilateral and bilateral ratios of the upper body, but to also evaluate the possible problems of muscular joints in amateur golfers. Male golfers (n=10) and a healthy control group (n=10) were recruited for the assessment of muscular function in the upper body, which was measured by an isokinetic dynamometer at 60°/sec. The tested parts were trunk, wrist, forearm, elbow, and shoulder joints. Mann-Whitney U-test was used to evaluate the significance of the differences between groups. The ipsilateral ratios of peak torque or work per repetition (WR) of trunk flexor and extensor in the golfers were not significantly different compared to those of the control group. These results were similar to the shoulder horizontal abductor and adductor. However, there were significant differences in the ipsilateral and bilateral ratios of the wrist, forearm, and elbow joints. Especially, the WR of the wrist flexor, forearm pronator, and elbow flexor on the left side of amateur golfers showed imbalances in bilateral ratios. Moreover, the WR of the wrist and elbow flexors on the left side of amateur golfers were lower than those of the wrist and elbow extensors. Therefore, amateur golfers should strive to prevent injuries of the wrist, forearm, and elbow joints and to reinforce the endurance on those parts of the left side.

Return to Elite Level of Play and Performance in Professional Golfers After Arthroscopic Hip Surgery

Background:

Hip conditions, such as femoroacetabular impingement and labral injury, can cause pain and limit the ability to play sports at a professional level.

Purpose:

To evaluate performance metrics of professional golfers prior to arthroscopic hip surgery and after surgery.

Study Design:

Case series; Level of evidence, 4.

Methods:

This study included professional golfers who underwent arthroscopic hip surgery. Primary outcome variables were greens in regulation and driving distance. Metrics were recorded for 2 years prior to arthroscopic hip surgery and 1, 2, and 5 years after arthroscopy.

Results:

A consecutive cohort of 20 male professional golfers (27 hips) from 2000 to 2011 underwent arthroscopic hip surgery by a single surgeon. All players were on the PGA Tour with a mean age of 38 years (range, 26-54 years). Eleven hips had labral repair and 16 had labral debridements. Four hips required microfracture of a chondral lesion. All players returned to play at a mean of 4.7 months (range, 1 month to 2 years). The mean number of years played after surgery was 5.72. There was no significant difference between preoperative and postoperative greens in regulation (P = .227). The mean distance per golf drive was significantly longer at 1 and 2 years postoperative compared with prior to surgery (P < .01), and driving distance at 5 years was also longer than preoperative (P = .008).

Conclusion:

Arthroscopic management of chondrolabral dysfunction due to femoroacetabular impingement in the professional golfer allowed the golfer to return to the same skill level prior to surgery. Mean driving distance was found to increase after arthroscopy, demonstrating not only a return but also an improvement in driving performance from prior level of play.

The crunch factor's role in golf-related low back pain

BACKGROUND CONTEXT

The golf swing exposes the spine to complex torsional, compressive, and shearing loads that increase a player's risk of injury. The crunch factor (CF) has been described as a measure to evaluate the risk of low back injuries in golfers and is based on the notion that lateral flexion and axial trunk rotation jointly contribute to spinal degeneration. However, few studies have evaluated the appropriateness of this measure in golfers with low back pain (LBP).

PURPOSE

To objectively examine the usefulness of the CF as a measure for assessing the risk of low back injury in golfers.

STUDY DESIGN

Field-based research using a cross-sectional design.

METHODS

This research used three-dimensional motion analysis to assess the golf swings of 12 golfers with LBP and 15 asymptomatic controls. Three-dimensional kinematics were derived using Vicon Motus, and the CF was calculated as the instantaneous product of axial trunk rotation velocity and lateral trunk flexion angle.

RESULTS

Maximum CFs and their timings were not significantly different between the symptomatic and asymptomatic groups. Furthermore, for those golfers who produced higher CFs (irrespective of the group), the increased magnitude could not be attributed to an increased axial angular trunk velocity or lateral flexion angle, but rather to a concomitant increase in both of these variables.

CONCLUSIONS

The findings suggested that although the fundamental concepts that underpin the CF seem sensible, this measure does not appear to be sensitive enough to distinguish golfers with LBP from the asymptomatic players.

Effect of spinal manipulative therapy with stretching compared with stretching alone on full-swing performance of golf players: a randomized pilot trial

OBJECTIVE

There has been a steady growth of chiropractic treatment using spinal manipulative therapy (SMT) that aims to increase the performance of athletes in various sports. This study evaluates the effect of SMT by chiropractors on the performance of golf players.

METHODS

Golfers of 2 golf clubs in São Paulo, Brazil, participated in this study. They were randomized to 1 of 2 groups: Group I received a stretch program, and group II received a stretch program in addition to SMT. Participants in both groups performed the same standardized stretching program. Spinal manipulative therapy to dysfunctional spinal segments was performed on group II only. All golfers performed 3 full-swing maneuvers. Ball range was considered as the average distance for the 3 shots. Treatment was performed after the initial measurement, and the same maneuvers were performed afterward. Each participant repeated these procedures for a 4-week period. Student t test, Mann-Whitney nonparametric test, and 1-way analysis of variance for repeated measures with significance level of 5% were used to analyze the study.

RESULTS

Forty-three golfers completed the protocol. Twenty participants were allocated to group I and 23 to group II. Average age, handicap, and initial swing were comparable. No improvement of full-swing performance was observed during the 4 sessions on group I (stretch only). An improvement was observed at the fourth session of group II (P = .005); when comparing the posttreatment, group II had statistical significance at all phases (P = .003).

CONCLUSIONS

Chiropractic SMT in association with muscle stretching may be associated with an improvement of full-swing performance when compared with muscle stretching alone.

The relationship between hip rotation range of movement and low back pain prevalence in amateur golfers: an observational study

OBJECTIVE

To investigate whether amateur golfers with self-reported low back pain have reduced hip rotation compared to asymptomatic controls.

DESIGN

Observational case-control study.

SETTING

Data collection took place at 2 amateur golf clubs in southern England.

PARTICIPANTS

On initial contact, all participants completed a screening questionnaire used to allocate participants into LBP (n=28) and control groups (n=36). LBP group were found to be heavier than controls (t=2.242, 95% CI 0.763-13.332) but were matched for age, height, handedness, handicap, rounds played per week and years of play.

MAIN OUTCOME MEASURES

Primary outcome measures were lead and non-lead hip medial and lateral rotation in 0 degrees of flexion as measured by inclinometer. Secondary measures included inter and intra-rater reliability.

RESULTS

The LBP group had significantly reduced lead hip passive (LBP 21.14+/-10.17 degrees; controls 31.06+/-8.06 degrees, t=-4.228, 95% CI -14.621--5.205) and lead hip active medial rotation (LBP 21.46+/-10.01; controls 28.06+/-7.49 degrees, t=-2.908, 95% CI -11.147--2.036) compared to controls. No between group differences were found in non-lead hips or any passive or active lateral rotation measures.

CONCLUSION

Although there is lack of causality between LBP and hip rotation, the deficit in lead leg medial hip rotation in amateur golfers who suffer LBP may be relevant for screening or treatment selection.

One-year follow-up study on golf injuries in Australian amateur golfers

BACKGROUND

Considering its popularity, little epidemiologic literature exists on golf injuries.

HYPOTHESIS

The low back is the most common injury location for golf-related injury. Most golf injuries occur as a result of the golf swing, and occur mostly at impact. The variables age, handicap, practice habits, and warm-up habits are associated with injury.

METHODS

A prospective survey over 1 year was used to study golf injuries among 588 golfers at 8 Australian golf clubs. Information collected included golfers' injuries sustained during the year, location of injury, onset, mechanism of injury, and whether injury occurred during the golf swing or at another time. Additional information was sought on the type of treatment received after injury. Logistic regression was used to examine the epidemiologic patterns of golf-related injury and any possible risk factors for the injury.

RESULTS

The overall 1-year incidence rate of golf injury was 15.8 injuries per 100 golfers, which equates to a range of 0.36 to 0.60 injuries/1000 hours/person. Recurrent injuries were most common, while injuries were more likely to occur over time as opposed to an acute onset. The lower back was the most common injury site (18.3%), closely followed by the elbow/forearm (17.2%), foot/ankle (12.9%), and shoulder/upper arm (11.8%). A total of 46.2% of all injuries were reportedly sustained during the golf swing, and injury was most likely to occur at the point of ball impact (23.7%), followed by the follow-through (21.5%). Multivariate analysis revealed that the amount of game play (odds ratio [OR] = 3.73, 95% confidence interval [CI] 1.29-10.75) and the last time clubs were changed (OR = 0.32, 95% CI 0.12-0.86) were significantly associated with the risk of golf injury (P < .05). Other factors such as age, gender, handicap, practice habits, and warm-up habits were not significantly associated with golf injury.

CONCLUSIONS

Nearly 16% of Australian amateur golfers may expect to sustain a golf-related injury per year. The injuries in golf are most likely sustained in the lower back region as a result of the golf swing. Based on statistical analysis, only game play and a changing of clubs seem to be significantly associated with risk of injury after adjusting for other risk factors (P < .05). Other factors such as age, gender, handicap, practice habits, and warm-up habits were not significant.

Is there an association between self-reported warm-up behaviour and golf related injury in female golfers?

Golfing injuries have been shown to occur frequently, and injury countermeasures have been suggested to help reduce injury risk. Performing an appropriate warm-up is thought to reduce injury risk, however there is a lack of evidence to support this notion. Therefore this study aimed to investigate the relationships between warm-up participation and injury in a cohort of female golfers. A total of 522 golfers participating in the Victorian Women's Pennant Competition completed the study. Over one-third (35.2%) of the golfers reported having sustained a golfing injury within the previous 12 months, with the lower back the most commonly injured region. Most golfers reported not warming-up prior to play or practice. Golfers who reported not warming-up on a regular basis were more likely to have reported a golfing injury in the previous 12 months than those reporting frequent warm-up participation (OR=45.2; 95% CI: 13.5, 151.7). Less skilled golfers were also less likely to report sustaining a golfing injury than more skilled golfers (OR=0.2; 95% CI: 0.1, 0.5). This study is one of the few to establish an association between warm-up participation and injury. Further prospective studies are warranted to determine whether warm-up reduces injury risk for golf participation.